Surgical treatment of symptomatic cavernous malformations of the brainstem

Sola, Rafael G.; Pulido, Paloma Contreras; Pastor, José María Cuadrado; Ochoa, M.; Castedo, José Luís

doi:10.1007/s00701-007-1113-5

Cited by 30 publications

(15 citation statements)

References 14 publications

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“…Commonly they are found in the brain, supratentorial being more frequent than infratentorial (80% vs. 20%). Most reports about posterior fossa CMs are brainstem ones, which generally present with significant focal neurological deficits (15,17,35,37,40,41). The cerebellar CMs are rarely reported, perhaps because surgery is usually safe and successful.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Cerebellar Cavernous Malformations: A Single-Center Experience with 58 Cases

Wang

et al. 2015

World Neurosurgery

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Cerebellar Cavernous Malformations: A Single-Center Experience with 58 Cases

Wang

et al. 2015

World Neurosurgery

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“…Outcomes are not directly comparable between some of the reported studies due to differing surgical indications, surgical approach guidelines, methods for the evaluation of neurological function, and follow-up durations, but our results were generally similar to those of prior series. 3,4,10,14,17,19,24,25,28,32,37,38,45,48,49,53,54,57,59,64,65,69 After a mean followup duration of 89.4 months, the condition of 89.7% of the patients was improved or unchanged, and permanent morbidity was observed in 26.9%. In most cases, surgical morbidity improved and did not have a significant impact on the patients' quality of life; additionally, patients developed coping strategies to live with these deficits.…”

Section: Long-term Outcomementioning

confidence: 98%

“…The surgical indications were as follows: 1) multiple hemorrhages (≥ 2), 4,32,54,59 lesion size (lesion equivalent diameter) ≥ 2 cm, and serious or progressive neurological deficit; 13,46,49,53,59,69 2) lesion location in the medulla oblongata; 39,60,69 3) acute or subacute hemorrhage with a significant mass effect; and 4) exophytic lesion or one abutting the pial surface accessible via the "safe entry zones." 32,46,49,54,59,65,69 The lesion size was evaluated as the lesion equivalent diameter (abc) 1/3 , where a, b, and c represent the 3 diameter measurements obtained, respectively, on axial, sagittal, and coronal MR images. Surgery was not recommended for patients with lesions that gradually diminished in size or whose hematomas disappeared.…”

Section: Hemorrhage Definition and Surgical Indicationsmentioning

confidence: 99%

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Hemorrhage risk, surgical management, and functional outcome of brainstem cavernous malformations

Yang

Hao

et al. 2013

JNS

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Object The aim of this study was to evaluate the pre- and postoperative rehemorrhage risk, neurological function outcome, and prognostic factors of surgically treated brainstem cavernous malformations (CMs) with long-term follow-up. Methods The authors conducted a retrospective review of the clinical data from 242 patients with brainstem CMs that were surgically treated between 1999 and 2010. Patient charts, imaging findings, and outcomes were examined. Results The study included 242 patients, with a male-to-female ratio of 1.3 and mean age of 32.6 years. The mean modified Rankin Scale scores on admission, at discharge, at 3 and 6 months after surgery, and at recent evaluation were 2.2, 2.6, 2.3, 1.8, and 1.5, respectively. The preoperative calculated annual hemorrhage and rehemorrhage rates were 5.0% and 60.9%, respectively. The complete resection rate was 95%. Surgical morbidity occurred in 112 patients (46.3%). Eighty-five patients (35.1%) demonstrated worsened condition immediately after surgery; 34 (41.0%) and 51 (61.4%) of these patients recovered to their baseline level within 3 and 6 months after surgery, respectively. At a mean follow-up of 89.4 months, the patients' condition had improved in 147 cases (60.7%), was unchanged in 70 cases (28.9%), and had worsened in 25 cases (10.3%). A total of 8 hemorrhages occurred in 6 patients, and the postoperative annual hemorrhage rate was 0.4%. Permanent morbidity remained in 65 patients (26.9%). The adverse factors for preoperative rehemorrhage were age ≥ 50 years, size ≥ 2 cm, and perilesional edema. The risk factors for postoperative hemorrhage were developmental venous anomaly and incomplete resection. The independent adverse factors for long-term outcome were increased age, multiple hemorrhages, ventral-seated lesions, and poor preoperative status. Favorable, complete improvement in the postoperative deficits over time was correlated with good preoperative neurological function and continuing improvement thereafter. Conclusions Favorable long-term outcomes and significantly low postoperative annual hemorrhage rates were achieved via surgery. Total resection should be attempted with an aim of minimal injury to neurological function; however, postoperative deficits can improve during the postoperative course. Close follow-up with radiological examination is proposed for patients with adverse factors predictive of rehemorrhage.

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“…While microsurgical resection represents the treatment of choice in accessible CCMs located under the pial or ependymal surface [12,13,26], the optimal management of symptomatic deep-seated, intraparenchymal brainstem CCMs is still under debate [16,17,27,28]. Microsurgical intervention for CCMs located in the brainstem harbors a significant risk.…”

Section: Discussionmentioning

confidence: 99%